NUR317 Low Back Pain and Intervertebral Disc Disease

What is localized low back pain?

Pain felt in a specific area of the lower back

What is diffuse low back pain?

Pain affecting a larger area and involving deep tissues

What is radicular pain?

Pain caused by irritation of a nerve root

What is referred pain?

Pain that is felt in the back but comes from another source

What are major risk factors for low back pain?

Lack of muscle tone, excess body weight, pregnancy, stress, poor posture, smoking, prior compression fractures, congenital spinal problems, and family history

What occupational factors increase the risk for low back pain?

Repetitive lifting, vibration, and prolonged sitting

What are common causes of low back pain?

Lumbosacral strain/instability, osteoarthritis, and degenerative disc disease/herniation

How long does acute low back pain last?

4 weeks or less

What commonly causes acute low back pain?

Trauma or undue stress

When do symptoms of acute low back pain usually appear?

Within 24 hours of the injury or stress

What symptoms can occur with acute low back pain?

Muscle aches to shooting pain, lcimited range of motion, and inability to stand upright

What is often found on diagnostic testing in acute low back pain?

Few definitive diagnostic abnormalities

What is the purpose of the straight-leg raising test?

To help assess for nerve root irritation/radiculopathy

What does the Trendelenburg test assess?

Weak hip abductor muscles and can help identify mechanical, neurological, or spinal disorders

What imaging may be used to evaluate low back pain?

MRI and CT scans

What subjective symptoms should the nurse assess in a patient with low back pain?

Interrupted sleep, pain in the back/buttocks/leg, numbness or tingling, constipation, muscle spasms, and activity intolerance

What medications should the nurse ask about when assessing low back pain?

Opioids, NSAIDs, muscle relaxants, corticosteroids, and OTC remedies

What past medical history is important when assessing low back pain?

Previous back surgery, epidural injections, trauma, and occupational risks

What objective finding may occur with low back pain?

Guarded movement

What may happen to the Achilles or patellar reflexes with nerve involvement?

They may be depressed or absent

What happens to the paravertebral muscles with low back pain?

They may become tense and tight

What happens to spinal range of motion?

It is often decreased

What does a positive straight-leg raise suggest?

Possible nerve root irritation

What tests can identify nerve root impingement?

Electromyography (EMG) and imaging such as MRI/CT

What are the overall goals for a patient with acute low back pain?

Adequate pain relief, return to previous activity, correct exercise performance, adequate coping, and self-management

What are important ways to prevent low back pain?

Proper body mechanics, maintaining a healthy weight, proper sleep positioning, smoking cessation, and regular strengthening/stretching exercises

How is smoking connected to low back pain?

Smoking can contribute to spinal/disc problems and impaired tissue healing, increasing the risk of back pain

Should patients with acute low back pain have prolonged bed rest?

No. A brief period of rest may be needed, but prolonged rest should be avoided

What types of exercise are recommended for low back pain?

Strengthening and stretching exercise

How often should strengthening/stretching exercises be performed according to these notes?

About 15 minutes in the morning and evening regularly

What activities should patients avoid if they increase pain?

Activities involving bending, lifting, twisting (BLT) and prolonged sitting

What is an appropriate sleeping position for someone with low back pain?

Side-lying with hips and knees bent and a pillow between the knees

How can a patient sleep on their back to reduce low back strain?

Place a support/lift under the knees and legs or a pillow under the knees to flex the hips and knees

What should patients avoid when bending down?

Do not lean forward without bending the knees

What should patients avoid lifting above?

Avoid lifting anything above the elbows

What sleeping position should be avoided with low back pain?

Sleeping on the abdomen or on the back/side with the legs straight out

What can cause chronic low back pain?

Degenerative/metabolic disease, weakness from scar tissue, chronic strain, and congenital spine problems

What is spinal stenosis?

Narrowing of the spinal canal

What is the most common acquired cause of spinal stenosis?

Osteoarthritis

What other conditions can cause spinal stenosis?

Rheumatoid arthritis, tumors, Paget’s disease, trauma, congenital spinal stenosis, and scoliosis

Where does pain from spinal stenosis commonly occur?

In the low back and radiates into the legs/buttocks

What makes spinal stenosis pain worse?

Walking

What relieves spinal stenosis pain?

Bending forward or sitting down

What neurologic symptoms can occur with spinal stenosis?

Numbness, tingling, weakness, and heaviness in the legs and buttocks

What medications may be used for chronic low back pain?

Mild analgesics, antidepressants, and sometimes opioids while considering their risks

What minimally invasive treatment may be used for chronic low back pain?

Epidural corticosteroid injections

What other minimally invasive option may be used to manage pain?

Implanted devices that deliver analgesia

What is the function of intervertebral discs?

They separate the vertebrae and absorb shock

What does intervertebral disc disease involve?

Deterioration, herniation, or other dysfunction of the intervertebral discs

What areas of the spine are commonly affected by disc disease?

The cervical and lumbar spine

What are common manifestations of radiculopathy?

Radiating pain, numbness, tingling, decreased ROM, and weakness

What condition may occur along with intervertebral disc disease?

Osteoarthritis

Where does pain from cervical disc disease commonly radiate?

Into the arms and hands

What is a common symptom of lumbar disc disease?

Low back pain

What type of pain can occur with lumbar disc disease?

Radicular pain that radiates along a nerve

What physical test may be positive with lumbar disc disease?

The straight-leg raise test

What happens to reflexes with lumbar disc disease?

They may be decreased or absent

What sensory changes can occur with lumbar disc disease?

Paresthesia, such as numbness or tingling

What motor changes can occur with lumbar disc disease?

Muscle weakness

What is cauda equina compression?

Compression of multiple nerve roots in the lower spinal canal

What are major signs of cauda equina compression?

Severe low back pain, progressive weakness, increased pain, and bowel/bladder incontinence

Why is bowel or bladder incontinence with lumbar disc disease an emergency?

It can indicate cauda equina compression and significant nerve damage

What diagnostic studies can be used for intervertebral disc disease?

X-rays, myelogram, MRI, CT scan, epidural venogram, discogram, and EMG

What is the first approach to treating many cases of intervertebral disc disease?

Conservative therapy- limitation of movement, local heat or ice, ultrasound and massage, skin traction, transcutaneous electrical nerve stimulation (TENS)

When is surgery considered for intervertebral disc disease?

When conservative treatment fails, radiculopathy worsens, bowel/bladder control is lost, pain is constant, or a neurologic deficit persist

Laminectomy

excision of part of vertebra (lamina)

Diskectomy

decompresses nerve root, microsurgical or percutaneous technique

Spinal Fusion

spine stabilized, bone graft fibula or iliac crest

What is an artificial disc replacement?

Surgical removal of a damaged disc and replacement with an artificial disc

What is an advantage of artificial disc replacement?

It allows movement at the level of the implant

What movement restrictions should be remembered after spine surgery?

BLT — No Bending, Lifting, or Twisting

What pain medications may be used during the first 24–48 hours after surgery?

Opioids, often through patient-controlled analgesia (PCA)

When should a patient transition from PCA/opioids to oral pain medication?

When able to tolerate oral medications

What other medication may be used postoperatively for muscle spasms?

Muscle relaxants

What should the nurse assess regarding pain?

Pain intensity and the effectiveness of pain management

What postoperative complication should the nurse monitor for after spinal surgery?

Cerebrospinal fluid (CSF) leakage

What symptoms may indicate a CSF leak?

Severe headache or clear/slightly yellow drainage from the dressing

What should the nurse do if CSF leakage is suspected?

Have the patient lie flat and notify the provider

What can be checked in suspicious drainage to help identify CSF?

Glucose

What is a major concern after cervical spine surgery?

Spinal cord edema